Incorporation of Pharmacist in Conducting Medication Reviews for Identification of Risk of QT Prolongation: A Neglecting Latent Approach in Cardiology
Abstract
Sudden cardiac arrest correlates with QT-interval prolongation and torsade de points (TdP). Several medicines frequently used in geriatric aged care populations can cause QT prolongation. Major predisposing factors and QT-prolonging medications enhance QT interval prolongation incidence in medical inpatients. Pharmacists can help ensure safe drug therapy and in-hospital patient safety by paying attention to QT prolongation and extra risk factors for prolonged QT intervals during medication reconciliation. We recommend pharmacists improve knowledge and awareness of corrected QT prolongation (QTc) when conducting drug reviews. Implementation of Pharmacist-driven QTc monitoring is required to lower the risk of QTc prolongation.
1. Das B, Ramasubbu S, Kumar B, Rawat V. Top 20 drug−drug interactions, polypharmacy and analysis of the nature of risk factors due to QT interval prolonging drug use in elderly psychiatry outpatients. J Fam Med Prim Care. 2020;9(12):6023-6040. .
2. Hondeghem LM. Drug-Induced QT Prolongation and Torsades de Pointes: An All-Exclusive Relationship or Time for an Amicable Separation? Drug Saf. 2018;41(1):11-17..
3. Bhuiyan TA, Graff C, Kanters JK, et al. The T-peak–T-end Interval as a Marker of Repolarization Abnormality: A Comparison with the QT Interval for Five Different Drugs. Clin Drug Investig. 2015;35(11):717-24.
4. Kallergis EM, Goudis CA, Simantirakis EN, Kochiadakis GE, Vardas PE. Mechanisms, risk factors, and management of acquired long qt syndrome: A comprehensive review. Sci World J. 2012;2012:212178.
5.Vandael E, Marynissen T, Reyntens J, et al. Frequency of use of QT-interval prolonging drugs in psychiatry in Belgium. Int J Clin Pharm. 2014;36(4):757-65..
6.Roden DM, Viswanathan PC. Genetics of acquired long QT syndrome. J Clin Invest. 2005;115(8):2025-32.
7. Van Noord C, Eijgelsheim M, Stricker BHC. Drug- and non-drug-associated QT interval prolongation. Br J Clin Pharmacol. 2010;70(1):16-23.
8. Drew BJ, Ackerman MJ, Funk M, et al. Prevention of Torsade de Pointes in Hospital Settings. A Scientific Statement From the American Heart Association and the American College of Cardiology Foundation Endorsed by the American Association of Critical-Care Nurses and the International Society . J Am Coll Cardiol. 2010;55(9):934–47.
9. Khatib R, Sabir FRN, Omari C, Pepper C, Tayebjee MH. Managing drug-induced QT prolongation in clinical practice. Postgrad Med J. 2021;97(1149):452-458.
10.Titelbaum N, Simpson M, Randall S, Peterson A. Toxicology QTc : So many formulae , but which one to use ? Available from: https://www.acep.org/toxicology/newsroom/feb2021/qtc-so-many-formulae-but-which-one-to-use/
11. Moss AJ, Schwartz PJ, Crampton RS, et al. The long QT syndrome. Prospective longitudinal study of 328 families. Circulation. 1991;84(3):1136–44.
12.Zareba W, Moss AJ, Schwartz PJ, et al. Influence of genotype on the clinical course of the long-QT syndrome. International Long-QT Syndrome Registry Research Group. New Engl J Med. 1998;339(14):960-5. .
13.Armahizer MJ, Seybert AL, Smithburger PL, Kane-Gill SL. Drug-drug interactions contributing to QT prolongation in cardiac intensive care units. J Crit Care. 2013;28(3):243–9.
14.Vandael E, Vandenberk B, Vandenberghe J, Spriet I, Willems R, Foulon V. Development of a risk score for QTc-prolongation: the RISQ-PATH study. Int J Clin Pharm. 2017;39(2):424-432.
15.Tisdale JE, Wroblewski HA, Overholser BR, Kingery JR, Trujillo TN, Kovacs RJ. Prevalence of QT interval prolongation in patients admitted to cardiac care units and frequency of subsequent administration of QT interval-prolonging drugs: A prospective, observational study in a large urban academic medical center in the US. Drug Saf. 2012;35(6):459-70.
16.Tisdale JE, Jaynes HA, Kingery JR, et al. Development and validation of a risk score to predict QT interval prolongation in hospitalized patients. Circ Cardiovasc Qual Outcomes. 2013;6(4):479–87.
17.Tisdale JE. Drug-induced QT interval prolongation and torsades de pointes: Role of the pharmacist in risk assessment, prevention and management. Can Pharm J. 2016;149(3):139–52.
18.Haugaa KH, Bos JM, Tarrell RF, Morlan BW, Caraballo PJ, Ackerman MJ. Institution-wide QT alert system identifies patients with a high risk of mortality. Mayo Clin Proc. 2013;88(4):315–25.
19.Berger FA, Van Der Sijs H, Becker ML, Van Gelder T, Van Den Bemt PMLA. Development and validation of a tool to assess the risk of QT drug-drug interactions in clinical practice. BMC Med Inform Decis Mak. 2020;20(1):171.
20.Noel ZR, Beavers CJ, Dunn SP, Schullo-Feulner AM, Caldas L, Dixon DL. Identifying core content for electrocardiogram instruction in doctor of pharmacy curricula. Am J Pharm Educ. 2018;82(10):7009.
21.Buss VH, Lee K, Naunton M, Peterson GM, Kosari S. Identification of patients at-risk of QT interval prolongation during medication reviews: A missed opportunity? J Clin Med. 2018;7(12):533.
22. Hutchins LM, Temple JD, Hilmas E. Impact of pharmacist intervention on electrocardiogram monitoring of pediatric patients on multiple QTc interval–prolonging medications. J Pediatr Pharmacol Ther. 2017;22(6):399-405.
2. Hondeghem LM. Drug-Induced QT Prolongation and Torsades de Pointes: An All-Exclusive Relationship or Time for an Amicable Separation? Drug Saf. 2018;41(1):11-17..
3. Bhuiyan TA, Graff C, Kanters JK, et al. The T-peak–T-end Interval as a Marker of Repolarization Abnormality: A Comparison with the QT Interval for Five Different Drugs. Clin Drug Investig. 2015;35(11):717-24.
4. Kallergis EM, Goudis CA, Simantirakis EN, Kochiadakis GE, Vardas PE. Mechanisms, risk factors, and management of acquired long qt syndrome: A comprehensive review. Sci World J. 2012;2012:212178.
5.Vandael E, Marynissen T, Reyntens J, et al. Frequency of use of QT-interval prolonging drugs in psychiatry in Belgium. Int J Clin Pharm. 2014;36(4):757-65..
6.Roden DM, Viswanathan PC. Genetics of acquired long QT syndrome. J Clin Invest. 2005;115(8):2025-32.
7. Van Noord C, Eijgelsheim M, Stricker BHC. Drug- and non-drug-associated QT interval prolongation. Br J Clin Pharmacol. 2010;70(1):16-23.
8. Drew BJ, Ackerman MJ, Funk M, et al. Prevention of Torsade de Pointes in Hospital Settings. A Scientific Statement From the American Heart Association and the American College of Cardiology Foundation Endorsed by the American Association of Critical-Care Nurses and the International Society . J Am Coll Cardiol. 2010;55(9):934–47.
9. Khatib R, Sabir FRN, Omari C, Pepper C, Tayebjee MH. Managing drug-induced QT prolongation in clinical practice. Postgrad Med J. 2021;97(1149):452-458.
10.Titelbaum N, Simpson M, Randall S, Peterson A. Toxicology QTc : So many formulae , but which one to use ? Available from: https://www.acep.org/toxicology/newsroom/feb2021/qtc-so-many-formulae-but-which-one-to-use/
11. Moss AJ, Schwartz PJ, Crampton RS, et al. The long QT syndrome. Prospective longitudinal study of 328 families. Circulation. 1991;84(3):1136–44.
12.Zareba W, Moss AJ, Schwartz PJ, et al. Influence of genotype on the clinical course of the long-QT syndrome. International Long-QT Syndrome Registry Research Group. New Engl J Med. 1998;339(14):960-5. .
13.Armahizer MJ, Seybert AL, Smithburger PL, Kane-Gill SL. Drug-drug interactions contributing to QT prolongation in cardiac intensive care units. J Crit Care. 2013;28(3):243–9.
14.Vandael E, Vandenberk B, Vandenberghe J, Spriet I, Willems R, Foulon V. Development of a risk score for QTc-prolongation: the RISQ-PATH study. Int J Clin Pharm. 2017;39(2):424-432.
15.Tisdale JE, Wroblewski HA, Overholser BR, Kingery JR, Trujillo TN, Kovacs RJ. Prevalence of QT interval prolongation in patients admitted to cardiac care units and frequency of subsequent administration of QT interval-prolonging drugs: A prospective, observational study in a large urban academic medical center in the US. Drug Saf. 2012;35(6):459-70.
16.Tisdale JE, Jaynes HA, Kingery JR, et al. Development and validation of a risk score to predict QT interval prolongation in hospitalized patients. Circ Cardiovasc Qual Outcomes. 2013;6(4):479–87.
17.Tisdale JE. Drug-induced QT interval prolongation and torsades de pointes: Role of the pharmacist in risk assessment, prevention and management. Can Pharm J. 2016;149(3):139–52.
18.Haugaa KH, Bos JM, Tarrell RF, Morlan BW, Caraballo PJ, Ackerman MJ. Institution-wide QT alert system identifies patients with a high risk of mortality. Mayo Clin Proc. 2013;88(4):315–25.
19.Berger FA, Van Der Sijs H, Becker ML, Van Gelder T, Van Den Bemt PMLA. Development and validation of a tool to assess the risk of QT drug-drug interactions in clinical practice. BMC Med Inform Decis Mak. 2020;20(1):171.
20.Noel ZR, Beavers CJ, Dunn SP, Schullo-Feulner AM, Caldas L, Dixon DL. Identifying core content for electrocardiogram instruction in doctor of pharmacy curricula. Am J Pharm Educ. 2018;82(10):7009.
21.Buss VH, Lee K, Naunton M, Peterson GM, Kosari S. Identification of patients at-risk of QT interval prolongation during medication reviews: A missed opportunity? J Clin Med. 2018;7(12):533.
22. Hutchins LM, Temple JD, Hilmas E. Impact of pharmacist intervention on electrocardiogram monitoring of pediatric patients on multiple QTc interval–prolonging medications. J Pediatr Pharmacol Ther. 2017;22(6):399-405.
| Files | ||
| Issue | Vol 10, No 3 (Summer 2022) | |
| Section | Brief Report | |
| DOI | https://doi.org/10.18502/jpc.v10i3.10798 | |
| Keywords | ||
| QT Interval Prolongation Drug-Drug Interaction Pharmacist Cardiology | ||
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How to Cite
1.
Hamza AU, Rizvi K, Ali K. Incorporation of Pharmacist in Conducting Medication Reviews for Identification of Risk of QT Prolongation: A Neglecting Latent Approach in Cardiology. J Pharm Care. 2022;10(3):175-179.
